Prevalence of Dysplasia with Recurrent Respiratory Papillomatosis Is High

What is the prevalence of dysplasia in recurrent respiratory papillomatosis?

Background: Recurrent respiratory papillomatosis (RRP) is a debilitating disease caused by the human papilloma virus (HPV). Between two percent and four percent of cases are reported to undergo malignant degeneration. Epithelial dysplasia is implicated in the progression towards malignancy.

Study design: Retrospective case series review

Setting: Two academic health centers

Synopsis: The authors reviewed 170 pathological specimens taken from 73 patients during a six-year period. They identified a degree of dysplasia in 13 percent (22 of 170) of the specimens. In addition, they found that 21.9 percent of patients had dysplasia during the period of review. One patient progressed from dysplasia to carcinoma in situ. No patients progressed to invasive squamous cell carcinoma. Although patients with dysplasia were older on average than patients without dysplasia (56.3 vs. 48.3 years old), this difference trended toward, but did not reach, statistical significance. Neither gender, tobacco use, operative frequency, nor cidofovir use were associated with increased rates of dysplasia. Findings between the two institutions, located in different geographic areas of the U.S., were nearly identical. The strengths of the paper are the large number of patients and pathological samples that were studied and the concordance of findings between the two institutions. The authors noted several shortcomings of the study. One weakness, aside from the retrospective design, is a relatively short study period. It is plausible that progression from dysplasia to malignancy may require a longer time period. Furthermore, HPV subtyping was not routinely performed and may have implications in RRP progression toward malignancy.

Bottom Line: The prevalence of dysplasia in patients with RRP is high (22 percent). There is no clear correlation with age, gender, tobacco use or surgical frequency.

Citation: Blumin JH, Handler EB, Simpson CB, et al. Dysplasia in adults with recurrent respiratory papillomatosis: incidence and risk factors. Ann Otol Rhinol Laryngol. 2009;118(7):481-485.

—Reviewed by Michael M. Johns, MD